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MAINT'EWNCE/REPAIR ORDER BLANKETCONTRACT NO <br /> PLEASE PRINT.ALL INFORMATION MUST BE LEGIBLE. Al _ 6010 A <br /> 'Y PRODUCTS COMPANY WORK ORDER NO. <br /> CONTRACTOR SERVICE STATION ADDRESS ` / ff STATION NO. PAGE s� <br /> 2 ® 4hG�` L-t✓{ s �-E-®c K_ ��7 g OF of <br /> REPORTED PROBLEM <br /> 0" <br /> WASJ08 COMPLETED <br /> YES ❑ NO <br /> SERVICES/REPAIRS PERFORMED LABOR CHARGES MATERIAL CHARGES <br /> MATERIAL DESCRIPTION <br /> SHOW MFG.NAMES&SERIAL NOS.IF PUMP TOTALIZER IS CHANGED,SHOW BEFORE&AFTER TOTALIZER READINGS. TIME RATE AMOUNT OTY. PRICE AMOUNT <br /> c1 s^ ) -13 fC./saa c <br /> Rie tel- r <br /> Q v C ? <br /> i <br /> TOTAL <br /> i <br /> LABOR CHARGE CORE CREDIT <br /> TOTALIZER READINGS TRAVEL TIME NO OF MILEAGE TO SITE SUBTOTAL ; <br /> PERSONS D 1 .c3Cs AND TIME AT SITE MATERIAL <br /> DISPENSER VENDOR'S EQUIPMENT VEHICLE MARK <br /> ' ' ' NUMBER UP% ' <br /> SERIAL NO. <br /> ITEM TIME RATE SUB- MARK AMOUNT ENDING ODOMETER READING TOTAL <br /> TOTAL UP% MATERIAL <br /> BEFORE EQUIPMENT SALES TAX ON ; <br /> RENTAL BEGINNING ODOMETER READING TOTAL MATERIAL <br /> AFTER SUB- TOTAL <br /> I LABOR CHARGE <br /> CONTRACTOR <br /> TOTAL MILEAGE TO SITE <br /> REMARKS CONTRACTOR CONFIRMED SERVICE CALL TOTAL <br /> TRAVEL TIME <br /> DATF TIME AM ARRIVAL TIME AT SITE NOTAL <br /> E <br /> PM i0 p PM <br /> PERSON CONTACTED AT SITE DEPARTUR TIME FROM SITE TOTAL <br /> AM VENDOR'S EQUIP. <br /> `,A 3� TOTAL <br /> PERSON WHO PLACED CALL TOTAL TIME AT SITE EOMP RENTAL <br /> TOTAL <br /> HRS3 U MIN. SUBCONTRACTOR <br /> SERVICE PERSON(PRINT NAME) SERVICE PERSON(PRINT NAME) BEFORE SIGNING FORM, AUTHORIZED SON(PRINT NAME) TOTAL ► <br /> �.. <br /> m.'c-1 VERIFY ARRIVAL TIME, <br /> SERVICE PERSON'S SIGNATURE SERVICE PERSON'S SIGNA URE DEPARTURE TIME, AND AUTHORI ERSON'S SIGNATU DATE <br /> �— SERVICES PERFORMED. 2.. <br /> cfiZ i.S3t 1 IRE\ cW PRIRTEI N U A <br /> ORIGINAL- ACCOUNTS PAYABLE <br />